Diabetes Health

Restricting Insulin to Lose Weight Increases Problems

Women with type 1 diabetes who take less insulin than they should to try to lose weight triple their risk of dying compared to women who do not skip insulin doses, according to a report in Diabetes Care.

"This is a very important women's health issue in diabetes," says Ann E. Goebel-Fabbri, Ph.D., lead author of the study.

"It happens at shockingly high rates, and, if we can detect this problem sooner and earlier, one would hope that we could direct patients to effective treatment," says Dr. Goebel-Fabbri.

Insulin treatment has been linked to weight gain. The practice of restricting insulin is referred to as "diabulimia," and is a dangerous way to shed pounds quickly.

Women at Risk for Eating Disorder

Previous studies have shown that women with diabetes are almost 2.5 times more likely to develop an eating disorder than women without diabetes.

Research also suggests that diabulimia can increase the risk of complications such as foot and vision problems, along with kidney damage, but there has been little research on mortality.

Persons with type 1 diabetes have completely lost the ability to produce their own insulin, the hormone necessary to move glucose into cells, where it is used for energy.

Regular injections of insulin essentially replace what the body used to produce naturally.

But shortchanging insulin doses means glucose levels are not controlled and, as the landmark Diabetes Control and Complications Trial established, persistently high blood glucose levels lead to serious complications, including eye and kidney trouble, and even death.

"Insulin is the hormone that allows the transport of glucose from the bloodstream into cells for use, so either the sugar gets used then and there for energy or it gets stored for later use," explains Dr. Goebel-Fabbri, a psychologist at the Joslin Diabetes Center in Boston.

"So, if you're not taking enough insulin, sugar increases in concentration in the blood, the body needs to find a way of excreting it, and the calories from that sugar get excreted in the urine," she says.

Unfortunately, half of adults with diabetes do not maintain recommended glycemic levels.

Screening Women Advised

This study included a total of 234 women, average age of 45, who were followed for 11 years. Participants had had diabetes for a mean of 28 years by the end of the follow-up.

Almost one-third of the women reported taking less insulin than they should.

These women tripled their risk of dying compared with women who did not restrict their insulin. They also died younger (45 versus 58) and had higher rates of kidney and foot problems.

Women in the two groups did not differ when it came to depression, anxiety, fear of hypoglycemia (low blood sugar), or general psychiatric symptoms. This left an eating disorder, rather than general psychological issues, as the likely culprit.

Dr. Goebel-Fabbri says physicians and other healthcare providers need to start including this kind of screening for diabetes.

Always consult your physician for more information.

May 2008

What is Insulin?

Insulin is a hormone produced by the pancreas that helps lower the blood sugar by moving sugar from the bloodstream into the cells of the body. Once inside the cells, blood sugar becomes the essential source of energy for the body.

Some people with diabetes may have to take a combination of two different types of insulin to control their blood sugar levels.

Some insulin can be purchased already mixed together, such as Regular and NPH insulin, to allow for injection of both types of insulin at the same time. Other types of insulin cannot be mixed together and may require two separate injections.

Insulin is manufactured at different strengths; U-100 insulin (100 units of insulin per milliliter of fluid) is the most common strength. The syringes for administering insulin are specifically designed for each different strength.

Therefore, a U-100 syringe can be used only with U-100 insulin.

The type of insulin chosen may reflect the person's preferences and ability to adhere to any given treatment regimen.

Other factors include an individual's:

willingness to monitor blood sugar levels regularly

daily activity levels (type and amount of exercise)

understanding of diabetes

stability of blood sugar levels

diet

Insulin has to enter the body's bloodstream to be effective. This is accomplished through injections into the fat layer - usually in the arm, thigh, or abdomen.

Different sites on the body allow the insulin to enter at different rates. Insulin injected into the abdominal wall works the fastest, whereas injection into the thigh works the slowest. Insulin must be administered to the body via an injection and cannot be taken by mouth because it is destroyed in the stomach during digestion.

The timing of insulin injections is very important. Insulin usually needs to be administered before mealtimes - before sugar from a meal starts to enter the bloodstream.